Insurers Save Costs at Cost of Skin Patients
April 13, 2021
Everyone, it seemed, was willing to help patients access medication without delay when COVID-19 took hold last year. Some health insurers waived out-of-pocket costs while others suspended prior authorization. One state issued a total ban on step therapy.
Skin patients, however, seemed to get overlooked.
As Washington, DC-based medical assistant Liz Hazuka sees it, insurers used the pandemic as an opportunity to reduce expenses by doubling down on delay tactics for dermatology treatment during the Public Health Emergency.
“Prior authorization forms are always onerous,” Hazuka recalled, “but the process seems even more difficult this year, especially if the doctor prescribed an off-label medication.”
But when off-label use benefitted the insurer’s bottom line, the situation was reserved. “Off-label use may be required,” according to Courtney Lamar, another medical assistant.
Lamar recalled a patient trying to get an FDA-approved biologic for his psoriasis. “The health plan required him to step through four other medications, including one that was not FDA indicated, before approving the prescribed biologic.”
Failing on multiple medications is counterproductive, especially during a pandemic. Psoriasis, an autoimmune condition, can cause skin irritation, inflammation and joint pain. Well-managed psoriasis makes patients more comfortable, and mitigates comorbidities such as cardiovascular disease and metabolic syndrome. Biologics taken by people with moderate-to-severe psoriasis may also affect how the body responds to the novel coronavirus.
“Insurers shouldn’t forget that skin conditions are more than skin deep,” Lamar warned.
Vaccines may help Americans get past the pandemic, but it’s going to take real policy change to eliminate the access barriers that will still plague skin patients even after COVID-19 is behind us.Tags: Biologics, Prior Authorization, Step Therapy
Categorized in: Blog